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2013-2014

Can health coaches improve decision making for elderly with cancer?

Researchers

VA HSR&D Fellow, CHP/PCOR

Background: Cancer is the second leading cause of death in the United States and disproportionately affects elderly patient populations. Many describe poor quality of life and experience, unnecessary suffering, and treatment options with little benefit. Additionally, many elderly patients with cancer also are less likely to receive a full diagnosis or engage in shared-decision making. No studies have evaluated the influence of health coaches and shared-decision making tools on patient and caregiver experiences and receipt of goal concordant care.

Objective: Determine whether shared decision making tools and provision of these tools by lay health coaches can improve receipt of goal-concordant care at the for elderly patients with cancer and improved patient experiences during a difficult diagnosis and care plan.

Methods: Randomized control design will be used with 120 patients into a control group with usual care delivery or intervention group. Intervention will consist of provision of health coaches and shared decision making tools regarding advanced care planning. Interviews will be conducted four times to obtain metrics regarding patient and family reported outcomes. Additional data collected regarding differences goal concordant care, rates of documentation of goals of care in the medical chart, and utilization of healthcare services (i.e. inpatient, emergency department, intensive care unit, outpatient, and hospice) and differences in costs of care.

Results: Health care coaches and shared decision making tools will improve goal concordant care, patient and family experiences and reduce health care costs.

Conclusions: Results will improve advanced cancer care for elderly patients and families and will inform additional studies to evaluate the use of the health care coaches and educational tools on all patients. The ultimate goal of the project will inform changes in public policy, health care financing, and clinical care to better align care with values and preferences and promote compassionate, high quality, cost-effective care.